Frequently Asked Questions

Most Americans are familiar with heart disease and the consequences of blockages in the vessels that carry blood to and from the heart. But few people realize that blockages caused by a buildup of plaque and cholesterol affect more than coronary arteries. The vascular system is like the highway of the body composed of arteries, veins and capillaries. Vascular disease is any condition of those almost 100,000 miles of blood vessels in the body, and any complication along this highway in the body can cause problems and health risks.

Vascular surgeons specialize in treatments of every kind of vascular problem except those of the heart and the brain. Vascular surgeons are highly trained specialists who manage the long-term care of patients with circulatory disorders at all stages, providing diagnosis, medical management, non-surgical solutions, checkups and intervention, both minimally invasive endovascular therapy and open surgery (when needed). Many vascular conditions are highly treatable. When surgery is needed, vascular surgeons are trained in all types of interventions, not just one or two. It is important to see a vascular surgeon even when surgery is not needed.

The vascular system consists of vessels that transport essential substances to and from the different parts of the body. Vascular disease is a condition that affects the arteries and/or veins. Most often, vascular disease affects blood flow either by blocking or weakening blood vessels or by damaging the valves that are found in the veins. Blood vessels that transport oxygen-rich blood and nutrients from the heart to the rest of the body are called arteries. Arteries can become blocked through a process called atherosclerosis. A buildup of plaque, a sticky substance made up mostly of fat and cholesterol, can build up along the walls of the arteries causing them to narrow. When this occurs in the legs the blood flow is reduced and the legs do not receive the proper amount of oxygen they need. This condition is known as peripheral arterial disease (PAD).

PAD affects 8 to 12 million people in the United States. The risk of PAD increases with age. Diabetes, smoking, high cholesterol, high blood pressure and obesity can also increase your risk for developing peripheral arterial disease. A family history of heart disease or stroke also elevates you chances for having PAD. African American and Hispanic ethnic groups are twice as likely to have PAD.

Often there are no symptoms in the early stages of PAD. Fatigue in the leg muscles that occur during activities such as walking or climbing stairs that goes away with rest is very common with PAD. You should inspect your feet for any sores or wounds that are slow to heal as well as changes in skin color (pale or blue), lower temperature of one leg compared to the other, and poor nail growth. Any of these symptoms could indicate you have circulation issues and would benefit from seeing a vascular surgeon.

If you are concerned about PAD have a discussion with your healthcare provider to review your risk factors and medical history. During a physical exam your provider will evaluate your pulses in your legs, and the appearance of your legs and feet. There are several simple noninvasive tests that can be performed. An ankle-brachial index (ABI) compares the blood pressure in the arms and legs. An ultrasound can also be done to measures blood flow to determine which arteries are narrowed or blocked. The ultrasound test can be performed in any PVA office during your appointment.

Several types of tests can be conducted to determine if someone has vascular disease. Here are the most commonly searched tests:

• Angiogram, a contrast dye-based X-ray procedure that can be both diagnostic and therapeutic. It is considered the gold standard for detecting and evaluating blockages in the arterial system. The procedure provides information that helps your vascular surgeon determine your best treatment options. Angiograms are typically performed while you are sedated. The procedure may last 15-20 minutes or up to several hours, depending on how difficult the test is and how much treatment is given.
• Ankle-Brachial Index or ABI Test, a quick non-invasive test to check for Peripheral Artery Disease compares blood pressure at the ankle with that at the arm. A low number can indicate narrowing or blockage of the arteries in your leg. For patients with non-healing foot wounds and diabetes, pressures in the toes themselves can even be measured noninvasively (TP or TPI).
• Carotid Duplex, a noninvasive test to see and measure the rate at which blood flows through your carotid arteries to look for possible blockages.
• Duplex Ultrasound, a noninvasive measure of blood flow of veins and arteries.
• Computed Tomography Angiography (CTA) and Magnetic Resonance Angiography (MRA) Tests, advanced imaging studies that provide detailed information about the blood vessels and their anatomic relationships with other organs.

Each patient referred to our office will receive a personal evaluation and treatment plan tailored to their specific symptoms, disease location, and other health factors. Treatment can include making lifestyle changes, taking medications and in some cases having an endovascular procedure or surgery. Only when necessary will traditional surgery be recommended.

• Abdominal Aortic Aneurysm (AAA), when an area of the aorta becomes very large or balloons out. AAA’s are highly hereditary.
• Chronic Venous Insufficiency, when valves in the veins (usually in the leg or sometimes the arms) don’t work, causing blood to pool in legs, putting increased pressure on the walls of the veins.
• Aortoiliac Occlusive Disease, blockage of the aorta or the iliac arteries. The iliac arteries are the branches that your aorta divides into around the level of the belly button to provide blood to your legs and the organs in your pelvis. This blockage is typically caused by a buildup of plaque within the walls of the blood vessels.
• Peripheral Artery Disease (P.A.D.), when plaque narrows the passageway within the arteries and causes them to become stiff limiting the blood flow or circulation to the legs.  P.A.D. can cause pain or aching in the legs, difficulty with walking, resting pain in the feet, non-healing sores or infections in the toes or feet.

• Driver’s license or State ID
• Insurance information
• Copies of any symptom related medical records (x-rays, MRIs, CT scans)
• Medications list (if any)

During your initial visit, you will be given a comprehensive medical evaluation and asked a series of questions. The doctor will then explain if he thinks you should have a specific test or procedure and detail any treatment options you may need.

Depending on your insurance, you may be required to provide a referral in order to see our physicians. It is recommended that you call your primary care physician or your insurance company for this information or you can call our office for help.

Your insurance has determined if you have a copayment to see a specialist. PVA has patient coordinators that can assist you with any payment questions or concerns.

As a convenience to our patients we provide several services in our offices.   All clinics offer a comprehensive in-office vascular ultrasound testing labs. Several of our locations have outpatient Cath Lab interventional suites where our physicians can perform procedures previously restricted to a hospital setting. We also have an in office prosthetic department that can provide prosthetic care. All these services can potentially be performed on the same day as you appointment if allowed by your insurance provider.

PVA physicians understand that vascular disease can have a complex presentation and that the best treatment is not always straight forward. PVA physicians are available to evaluate patients and provide a second opinion and go over all of the treatment options with patients, ensuring that all of their questions are answered.

Although physicians in our clinics can see patients for spider of varicose vein issues we often refer people with these issues to the Veintec Varicose Vein Clinics – San Antonio. These clinics are owned and operated by Peripheral Vascular Associates with board certified vascular surgeon ready to assist you. They can be reached at 1-866-570-6584 or at www.veintec.com.